Provider Demographics
NPI:1699000877
Name:FOURNIER, BENJAMIN AARON (RPH)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:AARON
Last Name:FOURNIER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 ALFRED ST
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-3128
Mailing Address - Country:US
Mailing Address - Phone:207-282-1577
Mailing Address - Fax:
Practice Address - Street 1:335 ALFRED ST
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-3128
Practice Address - Country:US
Practice Address - Phone:207-282-1577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-06
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR4848183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist